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Home Visiting Programs Manual

Bureau of Childhood Development

I. Introduction/Definition

The Bureau of Childhood Development administers community-based prevention and intervention programs to strengthen capacity of children, adolescents, women and men to make healthy decisions, utilize support systems, access opportunities, and achieve self-sufficiency.

Using the following evidence based models, the Healthy Families Illinois (HFI), Maternal Infant and Early Childhood Home Visiting (MIECHV), and Parents Too Soon (PTS) programs provide intensive home-visitation services to new and expectant families to strengthen the parent child relationship, encourage healthy child growth and development and nurture parents in their role as the child's first teacher and prevent child abuse and neglect.

Healthy Families Illinois (HFI) - Assists expectant and new parents identified as having a significant risk for child abuse/neglect to reduce that risk through intensive home visiting services.

Nurse Family Partnership (NFP) - Utilizes Nurse Home Visitors to assist low-income first time mothers and their children to improve their health and life-course.

Parents as Teachers (PAT) - Provides information, support and encouragement to expectant parents and parents with children ages zero to five.

Early Head Start - Home Based (EHS/HB) - Support and enhance the continuum of infant and toddler growth and development; support parents to fulfill their parental roles and move toward self-sufficiency.

Each MIECHV community will have a coordinated intake process to assure that families have a central point of entry for services. The coordinated intake provider will assist families in determining the services and supports that are best suited for their needs.

II. Policies and Procedures

Subject to Department review and approval, providers will maintain and adhere to written policies and procedures for at the least the following elements.

The characteristics of the population targeted for services, including at a minimum geographic area, age, race, ethnicity, language and income. Programs must at a minimum adhere to the following eligibility criteria:

HFI - determined through either the eligibility screen or Family Stress Checklist to be at risk for child abuse and/or neglect

NFP - first-time parents at or below 185% of the Federal Poverty Level

PAT - parents at or below 185% of the Federal Poverty Level

Identification and referral of potentially eligible participants within the following time frames:

HFI - Prenatally or within two weeks of birth

NFP - Prenatally, prior to the 28th week of gestation

PAT - Prenatally or prior to the child's first birth date

III. Contract and Amendment Process

Contract Process

The contract between the Department and the Provider is generally referred to as the Agreement and consists of several parts:

Community Service Agreement, containing the standard contract language used for all Department contracts

Exhibit A, containing Scope of Services/Purpose of Grant

Exhibit B, containing Deliverables

Exhibit C, containing Payment Information

Exhibit D, containing Contact Information

Exhibit E, containing Performance Measures

Exhibit F, containing Performance Standards

Exhibit G, containing State Agency Contracts

Attachment E

The Program Manual, attached by reference to the Agreement, contains the program service provisions.

The Department will initiate the contract by having it online for the Provider to obtain and sign. The Provider will fax signature page to the Department to obtain the Secretary's signature and the Department will return a copy of the executed signature page of the contract to the Provider via pdf email.

Amendment Process

There are two types of amendments to an executed Community Service Agreement.

Letters of increase or decrease - A letter is sent to the Provider stating the intent to increase or decrease dollars to specific program services existing in the Community Service Agreement. There is no need for the Provider to sign and return this document.

Formal amendments - A two-party signed agreement to an executed Agreement is a formal amendment. The following process is required for a formal amendment to be processed:

Adding new program services - An amendment to add a new program service must contain a detailed summary of services to be provided under the executed Community Services Agreement and a method of payment.

Extending the service dates of the Community Services Agreement* - An amendment to extend the service dates of the Community Services Agreement must contain the following information: Agreement number as it appears on the original Community Services Agreement; Provider name; clause stating the new term of the Agreement; signatures of the Provider and the Secretary of the Department of Human Services.

*NOTE: A Community Services Agreement end date should be June 30, due to mandates in the State Finance Act regarding audit period. Language on pages one through nine in the Community Services Agreement may not be changed.

Extending the service dates of an existing program attachment - An amendment to extend the date of a specific attachment in the existing Community Services Agreement must contain the following information: Agreement number as it appears on the original Community Services Agreement; Provider name; clause stating the new term and the specific attachment name and number; signatures of the Provider and the Secretary of the Department of Human Services.

Changing language within an existing program attachment - An amendment to change language in an existing program attachment of the Community Services Agreement must contain the following information: Agreement number as it appears on the Community Services Agreement; Provider name; clause(s) stating the new language; signatures of the Provider and the Secretary of the Department of Human Services.

IV. Deliverables/Costs/Payments

Payments to the Provider will be made on a prospective basis, rounded to the nearest $100.00. The final prospective payment may be greater or lesser than the previous payments due to rounding.

The Department will compare the amount of the prospective payments made to date with the documented expenditures provided to the Department by the Provider. In the event the documented services provided by the Provider do not justify the level of award being provided to the Provider, future payments may be withheld or reduced until such time as the services documentation provided by the Provider equals the amounts previously provided to the Provider. Failure of the Provider to provide timely documentation may result in a reduction to the total award.

The final payment from the Department under this Agreement shall be made upon the Department's determination that all requirements under this Agreement have been completed, which determination shall not be unreasonably withheld. Such final payment will be subject to adjustment after the completion of a review of the Provider's records as provided in the Agreement.

The Department may provide a staffing formula for the program.

V. Provider Responsibilities

Healthy Families Illinois/MIECHV

Providers must submit for Department approval a Program Plan in a format/time frame provided by the Department.

Providers must maintain local policies and procedures for the following activities:

Tracking trends related to the target population and adjustment to program plans as indicated.

Provision of services that are culturally relevant to the population served.

Increase/decrease in the intensity of home visiting services; termination of home visiting services.

Termination home visiting services

Outreach and re-engagement

Monitoring by caseload and program, the percentage of families who receive 75% or more of the expected home visits.

Maintenance of a supervisory log/ledger containing documentation of supervision, team meetings, field observations, training and other staff development

Maintenance of training log for each direct service staff and supervisor documenting the completion of all job specific and ancillary training.

Benchmarks for annual acceptance and retention rates.

On-going quality assurance, including client/staff survey.

Community advisement.

Compliance with mandated reporting requirements.

Compliance with the Health Insurance Portability and Accountability Act of 1996.

Developmental Delay Screening, utilizing a research-based screening tool, must be completed at the intervals required by the program model. (For Parents As Teachers programs, Hearing and Vision Screenings must also be completed at the intervals specified by the program model).

Providers will assist participating families to connect with medical providers, and when appropriate, Family Case Management and the Women, Infant and Children (WIC) program.

Providers will participate in the Department's efforts to improve the health and well-being of families enrolled in program services.

Prior approval from the Department must be secured prior to any anticipated change in to the program model.

The Provider is required to comply with performance standards as delineated by the Department and referenced in letter.

Staffing, Education and Training Requirements

Program staff should be representative of the ethnic/cultural diversity of the community served and meet the following educational requirements. The ratio of supervisors to direct service staff must be in compliance with the program model requirements.

HFI - Supervisors, hired after September 1, 2004, must have at least a Bachelor's degree; Family Assessment and Family Support Workers must have at least a high school diploma, or its equivalent.

NFP- Supervisors must be Bachelor's degree prepared Registered Nurses; Nurse Home Visitors must be Registered Nurses

PAT - Supervisors must have a Bachelor's degree in early childhood education; Parent Educators must have at least a high school diploma, or its equivalent

Program staff, Supervisors and Home Visitors, must have role-specific training, as required by the specified program model, within six months of hire. Additional training required by the program models must be completed within the time frames specified by the model.

Reporting Requirements

Providers will maintain, at a minimum, an individual case record for each family enrolled in the home-visiting program.

Utilizing a format provided by the Department, providers will submit a quarterly data collection form by the last day of the month following the end of each quarter.

With written consent from the participant, the provider will use the Cornerstone information management system, or its successor (s) to record all information on program participants, and the activities of program staff.

The Provider will submit data, in a manner specified by the Department, which documents the program's performance on the federally mandated benchmarks for the Maternal, Infant, and Early Childhood Home Visiting program.

Parents Too Soon

The Provider shall subcontract with community service agencies to offer the Parents Too Soon/Healthy Families Illinois, Parents Too Soon/Nurse Family Partnership and Parents Too Soon/Parents as Teachers, home visiting program services. The sub-contracts are to be approved by the Department prior to execution.

Program and Spending Plan
The Provider shall submit to the Department the Parents Too Soon/Parents as Teachers, Parents Too Soon/Healthy Families Illinois and Nurse Family Partnership and Educare program and spending plans by subcontractor agency by the 45th day after the start of the fiscal year.

Reports

The Provider shall submit to the Department the subcontractor quarterly Ounce net report by Provider and overall for the State within 45 days after the end of each quarter.

The Provider shall submit to the Department the "Teen Pregnancy Prevention Common Outcomes" within 45 days after the end of each quarter. Format to be determined by the Department.

The Provider shall submit to the Department the annual report 45 days after the end of the fiscal year. Format of the annual report to be determined by the Department.

The Pregnant and Parenting subcontractor agency services include, but are not limited to:

weekly parent group meetings and home visits,

developmental delay screening utilizing a research-based screening tool (e.g., ASQ, Denver Developmental screen) must be completed for each target child at intervals prescribed by the tool until the child is 3 years of age,

parenting skills education,

immunization and EPSDT compliance,

education on family planning including abstinence education, and prevention of sexually transmitted infections and HIV/AIDS

upon completion of training and with consent of the families, provider will videotape parent-child interaction twice yearly,

promotion of delay of subsequent pregnancy,

monitoring of below post secondary school progress, and

Family Life Education

Parents Too Soon/Healthy Families Illinois subcontract agencies shall abide by the provisions of the Healthy Families Illinois program as described in the Fiscal Year 2009 Department Program Manual.

Funds are provided to support salary, fringe benefits, travel and equipment for an adolescent development program coordinator as identified by the Department. The Department will approve the time reporting for such staff on a basis consistent with the Provider's payment frequency.

The Provider is required to comply with performance standards as delineated by the Department and referenced in letter.

For Programs Using the Cornerstone Data System

The agency must purchase and maintain a business class contract with an Internet Provider Service (ISP).

Interruption of communication and/or connectivity must be reported within 24 hours to the agency's ISP and the Cornerstone Service Desk.

Cornerstone User access must be approved and terminated by an appropriate section manager responsible for Cornerstone security management within the Cornerstone agency.

Security training is required before Cornerstone users are allowed access to the system and annually thereafter

Reasonable action, due care, and due diligence must be taken to prevent inappropriate use, disclosure, destruction or theft of Cornerstone-designated IT resources. Reasonable actions include but are not limited to prevention, detective and corrective measures such as encryption, anti-viral software and application of security patches.

Disclosure of Cornerstone information is restricted only to authorized parties and in a manner consistent with the form of data classification.

Cornerstone-designated IT resources must for approved use only. Approved use is limited to authorized users, sanctioned Cornerstone business and job responsibility.

Only approved software and hardware are authorized to be loaded on Cornerstone-owned IT resources:

Users are not authorized to run software that has not been approved by Cornerstone technical staff.

Users are not authorized to attach hardware not approved by Cornerstone technical staff including but not limited to modems or non-Cornerstone-designated IT resources such as portable computers or other digital storage or writing devices.

Only approved software may be used to develop applications or to manipulate data.

VI. Department Responsibilities

The Department will provide technical assistance and monitoring for all programs operated under the Division of Family and Community Services.

VII. Support Services

Utilization of Community Resources - It shall be the responsibility of each project director to coordinate the services provided through the project with other sources of care in the community, such as:

The Illinois Medical Assistance Program

Local Health Departments/Medical Providers

Neighborhood Health Centers

Local Child Development Clinics

Division of Specialized Care for Children

Local Hospitals

Local Children and Family Services Programs

Local Schools

Vocational Rehabilitation Services

Regional Perinatal Centers

Local Early Intervention Programs for Infants and Toddlers with Handicaps

Other related social service agencies

Please refer to 77 Ill. Adm. Code 630.160 and 630.170; Other Applicable Rules; and to the program-specific Exhibits for additional requirements.

VIII. Billing Instructions

Providers shall use the following methodology to document the use of these funds:

The Provider shall provide summary documentation by line item of actual expenditures incurred for the purchase of goods and services necessary for conducting program activities. The Provider shall use generally accepted accounting practices to record expenditures and revenues as outlined in DHS Rule 509, Fiscal Administrative Recordkeeping and Requirements.

Expenditures shall be recorded in the Provider's records in such a manner as to establish an audit trail for future verification of appropriate use of Agreement funds.

Expenditure documentation shall be submitted in a format, defined by the Division of Family and Community Services on a monthly basis, within fifteen days of the end of the month reported.

The Provider shall submit expenditure documentation by one of the following means to the individual listed below:

IX. Program Monitoring

The Provider shall permit Department staff to conduct accompanied and unaccompanied site visits of service delivery providers for the purpose of observation and discussion of programmatic and operational content and understanding.

X. Program Budget

Providers agree to establish and utilize a spending plan approved by the Provider's Board of Directors.

XI. Applicable Rules and Statues

The Provider shall provide services as set forth in the pertinent portions of the FCS Program Manual and shall act in accordance with all state and federal statutes and administrative rules applicable to the provision of the services, including, but not limited to the following:

Federal Rules:

42 CFR 430 et seq.: Medicaid provisions of Title XIX of the Social Security Act and its rules

42 CFR 431.300 - 431.307: Medicaid provisions of Title XIX of the Social Security Act and its rules, specifically provisions regarding "Safeguarding Information on Applicants and Recipients"

42 CFR Part 50, Subpart C: Policies of General Applicability, Abortions and Related Medical Services in Federally Assisted Programs of the Public Health Service

The State General Revenue Funds disbursed through the Department of Human Services, Division of Family and Community Services, are usually Maintenance of Effort (MOE) or Temporary Assistance for Needy Families (TANF) matching funds. Therefore, these funds are generally treated as FEDERAL FUNDS at the end of the fiscal year. Such treatment of State General Revenue Funds as Federal Funds may cause the Provider to fall under the audit requirements of OMB Circular A-133. This knowledge can be used to avoid unnecessary additional costs when requesting year-end fiscal audits. The Provider is therefore advised to notify their independent auditor (CPA) of this possibility.